strategic housing for older peoplea comparatively fit and healthy early old age with relative wealth...

STRATEGIC HOUSING FOR OLDER PEOPLE

Planning, designing and delivering housing that older people want

SECTION A: Older People and Housing

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Section A: Paper 1 Older People and Housing 1

SECTION A: Older People and Housing – Understanding demand and supply for older people’s housing, care and support

Contents

Foreword 2

BRIEFING PAPERS:

PAPER A1: Older People and Housing 4

PAPER A2: Understanding local demand from older 9people for housing, care and support

PAPER A3: Understanding the local market for older 21people’s housing, care and support

TOOLS AND RESOURCES:

A1 Reviewing housing need and demand amongst 34older people – a checklist

A2 Data sources for help in estimating need and 35demand and understanding the market

A3 Conducting focus groups of pre-retirement populations designed 39to explore their responses to future problems as they age

A4 Assessing the capacity of current sheltered housing to 41meet future needs

A5 Developing an accommodation strategy 43

A6 Developing a Market Position Statement for housing 45for older people

2 SECTION A: PAPER 1 Older People and Housing

ForewordOur response to an ageing society is shaped by widely-accepted principles.Delivering housing and care services based around those ideals of personalisation,living well at home, independence and choice is the challenging bit.

In 2010, the Department of Health recognised this by pledging to update its extracare housing toolkit and offering local authorities £20,000 each to encourage themto produce robust housing with care strategies.

This document fulfils the Department’s pledge – and goes further by providing acomprehensive analysis of the issues local authorities and their partners need toconsider in developing these strategies. It also outlines the range of housing withcare options that should be available to older people.

A strategic approach to housing with care will help older people to live well athome for longer, providing many with a home for life – a home they actually wantto live in. That is good for older people and good for the public purse.

Well-planned and designed extra care housing, for example, offers a lifestylechoice to older people who require some level of care and support. Research hasshown such housing can improve health and wellbeing – reducing hospitaladmissions and other demands on the NHS and adult social care budgets.

That research is reinforced by the independent evaluation of the Department ofHealth’s Extra Care Housing Fund, which is published at the same time as thisResource Pack.

More importantly, it also meets the aspirations of a generation of older people usedto choice and quality design, many of whom prize their independence. They mighthave retired but they have no intention of retiring from the world. Few of thesepeople do not need or want to follow the well-trodden path into residential care.

With the construction industry and financiers still cautious, local authorities mustlead in creating the conditions and confidence that allow the aspirations of the‘new old’ to be met. This Resource Pack, endorsed by the Association of Directorsof Adult Social Services (ADASS), provides the analysis, measures and tools thatwill allow councils and their partners to set about assessing, stimulating andmeeting demand for different housing options.

If we are to ensure they have homes they actually want to live in as their careneeds increase we need to do a lot more than simply count or predict the numbers of older people.

Jeremy Porteus Director, Housing Learning and Improvement Network

Peter Hay President, Association of Directors of Adult Social Services

December 2011

SECTION A, PAPER A1

Older People and Housing

This briefing paper forms part of Section A of the Strategic Housing for Older People Resource Pack. Section A discusses the wider policy context of housing for older people, and how we might better understanddemand and supply in the market.

References are made to practical Tools and Resourcesprovided at the end of the Section. These have beendesigned to support planners and developers in developing a strategic approach to meeting the housing needs andaspirations of older people.

Section B of the Pack looks in more detail at the effectivedelivery of extra care housing in particular, and containsfurther Tools and Resources. A comprehensive bibliographyand webliography is provided in Section C.

Introduction

Most people are aware that Britain along with most other Western countries has anincreasing older people’s population. That increase, a rise by nearly 90% over thenext twenty years is most marked in the population aged 80 and over, the group mostlikely to need some care and support. Making sure that there is housing suitable forthat population in both the private and public sector is vitally important. Making surethat such housing not only diminishes people’s need for care and support but is alsoan attractive, desirable and financially viable option represents a significant challenge.

This paper considers the policy context at the current time, and the key challengesthis presents for commissioners, funders and providers as they seek to plan, designand deliver housings that older people want.

4 SECTION A: PAPER 1 Older People and Housing: An introduction

Changing timesIn 2008 the government published a significantpolicy paper ‘Lifetime Homes, LifetimeNeighbourhoods’1. Underpinning the documentwere three key assumptions:

• That specialist housing for older people shouldnot just mean social housing but all forms ofhousing in which older people might live.

• That if more older people are to remain intheir own homes then this requires theintegrated activity of the local authority andthe health service, and

• Finally, that staying in the community meansmore than just good housing it meansdeveloping communities that ‘work well’ for older people.

Such aspirations hardly represent new policyobjectives yet the contexts in which they operateare radically different from those that pertainedwhen the Welfare State first came into being.

1 Department for Communities and Local Government (2008). Lifetime Homes, Lifetime Neighbourhoods: A National Strategy forHousing in an Ageing Society.

“We all want to ensure that we can stayindependent in our own homes as long aspossible. But age brings with it a greateracknowledgement of interdependence

with family, community, services, andneighbourhood. To achieve the right

balance means looking at planning fornew homes and neighbourhoods which

can sustain the changes of a lifetime;providing impartial information at anearlier stage so that people can makebetter informed and more confident

decisions; greater choice of qualityhousing options; increased support toenable people either to stay in their ownhomes or to move on, and better, more

integrated housing support services”.

Department for Communities and Local Government (2008). Lifetime Homes, Lifetime

Neighbourhoods: A National Strategy for Housing in an Ageing Society.

As the policy paper points out, “In 1950, theaverage man retired at 67 and could expect tospend 10.8 years in retirement.” Now lifeexpectancy at age 65 in the UK is for anadditional 17.6 years for males and 20.2 yearsfor females2.

There has been a huge shift in homeownership. In 1900, about 90% of thepopulation rented their home, the majority from private landlords. By 1939 the move tohome ownership had begun with about 27%of the population owning their own house.

That figure is now estimated to be just under70%3. For older people the change is evenmore marked. Of the 5.5 million 65+households in England, 75% are homeowners;a fifth live in social housing and only 5% live in the private rented sector. Of particularsignificance for future market development,nearly 50% of all housing equity is held bypeople aged 65 and over4.

Finally, being a pensioner does not necessarilyequate with poverty as it so often did in thepast. Whilst there remains a sizeable group ofolder people who are income poor, despiterecent stock market fluctuations and inflation,average pensioner incomes have risen fasterthan average earnings since the mid 1990sincreasing by an estimated 44% in real termsbetween 1994/95 and 2008/095. Some of thisis not only due to older people releasing theequity in their property as income but is alsodown to a growth in occupational pensions.These now account for over one fifth ofaverage gross income for single older peopleand over a quarter of average gross incomes for married pensioner couples6.

Delivering choiceWhilst older people may own more property,live longer and be wealthier, it does notnecessarily mean that this is matched by goodhealth or that the choices available to peoplein older age have kept pace with demographyor incapacity. There is still a sizeable minorityof older people who depend on a state pensionand live in family-sized social rented orprivately rented housing. For example, it isestimated that 20% of general needs socialhousing is occupied by an older householder.

As a number of commentators have observed, oldage is increasingly dividing into two periods of life:a comparatively fit and healthy early old age withrelative wealth and prosperity, and an older, oldage where incapacity and ill-health are moreprevalent. Often it is the housing choices made inearly old age that will influence the well being andlifestyle of individuals in the latter stages of life.

With regard to choice, given that the majorityof older people live in owner occupied housing,and the bulk of housing and care services are in the private and voluntary sector, it mightseem as if the capacity for choice and for amarket driven by consumers already exists.

SECTION A: PAPER 1 Older People and Housing: An introduction 5

2 Office for National Statistics.

3 House of Commons (21 December 1999). A Century of Change: Trends in UK statistics since 1900. Research Paper 99/111

4 Ball M (2011). Housing markets and independence in old age: expanding the opportunities. Henley, University of Reading.

5 Office for National Statistics. Pension Trends 2008.

6 Ibid.

“It certainly looks as though total lifeexpectancy in the UK is increasing faster

than either the expectation of life in goodhealth or the expectation of life without

limiting longstanding illness.”

Oxford Institute of Ageing (2006). Increasing Life Expectancy and the Compression of

Morbidity: A critical review of the debate.

Only those dependent on local authority orRegistered Social Landlord (RSL) provision mayhave a more restrained set of choices in theirhousing options. Yet choice for many older peoplemay be far more limited than it initially appears:

• If people wish to move, perhaps because theyhave some degree of physical incapacity, thechoice may often seem limited. Options liebetween remaining in a family home notdesigned for the delivery of health and careservices, living in small, rented, sheltered housingor moving to a care home. Consequently, anumber of older people end up feelingtrapped in their family home faced eitherwith a move that is unacceptable or living ina property which they find increasingly hardto financially and/or physically manage.

• Purchasing housing designed and suitable forolder people may not always be an optiondue to limited availability. For example, sevenLondon boroughs have no retirementhousing for sale of any kind although 66%of their population aged 65 and over areowner occupiers.

• Older people may not be aware of the range ofaids and adaptations that are available tosupport them to live independently in their ownhomes or, with increasing pressure on resources,are finding it difficult to access them at all.

• Who makes the decision aboutaccommodation is also open to debate. Astudy in 2004 stated that among a smallsample of older people going into carehomes, none of them felt that they made thedecision; instead the choice was exercised byrelatives or health and social care staff7.

• In many rural areas local authorities talk aboutthe difficulty of getting social care providers tooffer a service that they can afford, let aloneprovide a choice of providers or services.

• Even funding your own care may not alwaysmean that what you want is available. Forexample, few would argue that self-fundersin the residential care sector have drivenchange. In many instances for those needingcare there may be a choice of provider, butnot a choice of service, of worker or of thetime that the service is delivered?

There are a number of reasons why this situationhas arisen. Planning authorities and governmenthave seemed blind to the need for a sizeableincrease in housing suitable for older people, onlyseeing housing problems in terms of the demandfor family housing. Housing providers anddevelopers find it hard to fund developmentswhere all the costs are up front and where themarket is uncertain and in many areas untested.Selling the concept of housing with care andsupport can be difficult given the plethora of termsused to describe this form of housing, somethingwhich equally seems to confuse both planners andregulators. Architects still seem to design housingfor older people as institutions where in manyinstances the latest model still looks like a crossbetween a motorway lodge and a care home.

Despite publications, such as the innovative HAPPIreport8, the notion of a wide choice of rented orpurchased property for older people of differentdesigns, tenure arrangements and prices still seemsa long way off. As was recently pointed out9, ifeven the present market share of owner occupiedretirement housing was maintained it wouldrequire the development of 5,300 dwellings peryear for the next twenty years. If choice was to beelevated to a meagre 5% market share, the annualtotal required would be 16,000 per annum.

Therefore, the challenge is considerable andimmediate given the time it can take for newhousing to move from concept to completion.


7 Kerslake A and Stilwell P (2004). What makes Older People choose Residential Care and are there alternatives? Housing Care and Support; 7 (4): 4-8.

8 Homes & Communities Agency (2009). Housing our Ageing Population: Panel for Innovation (HAPPI) report.


It is a challenge not just for public sector housingbut also for the private sector, given the highlevels of home ownership amongst older people.It is a challenge for planners and architects andalso to those who fund housing development,to recognise the substantial change that willneed to take place in the way our communitiesare designed over the coming years.

Drivers for changeThe one certainty is that the past way we havethought about, designed and funded housingfor older people needs to change. With anemphasis on choice and individuals havingfunding, either through their own resources or

from a personal health and social care budget,there is a need to seek housing and caresolutions that are much more positive andattractive than those that have been seen asappropriate in the past.

In the future, developments should be of housingsuitable for older people rather than the morestigmatising ‘older people’s housing’. It shouldbe housing which people look at and welcomewith a “wow” rather than housing where theunderlying message is, “has it come to this?”

Some of the potential drivers through whichthis might be achieved are summarised below,as well as further explored in the range ofpapers in this Strategic Housing for OlderPeople Resource Pack.

SECTION A: PAPER 1 Older People and Housing: An introduction 7

ASPIRATIONS AND DRIVERS

Provide greater choice giventhe significant levels of owneroccupation amongst the older population.

Encourage a planning, fiscaland regulatory environmentthat stimulates thedevelopment of new types ofhousing for older people.

IMPLICATION FOR COMMISSIONERS AND PROVIDERS

Housing developments suitable for older people need to offer a choice oftenure, with more options for outright purchase or shared ownership. Thisshould match the tenure make-up of the market.

This may also mean local authorities freeing up land in prime sites fordevelopment, planners being much better versed in the needs of olderpeople and financial incentives to developers to develop innovative housing approaches.

Planners need to be aware, particularly in areas of high density of olderpeople, of what makes a good neighbourhood to live in. This is not just interms of housing, but in terms of street architecture and facilities, such aslighting, drop curbs, public toilets, etc, in transport and in service availability.

Planners and regulators currently have varying views about the status ofhousing with care or extra care housing, for example whether it should betreated as a residential care home in planning terms, or as a form ofhousing. This ambiguity does not help the development of extra carehousing locally, and means both commissioners and providers need to workto ensure clarity about what they are trying to achieve with key stakeholders.

In Denmark around 8% of Danes aged over 50 now live in Co-Housing10,yet the traditional housing models of freeholds and mortgages are oftenobstacles to this kind of development in the UK.

10 See http://www.vivariumtrust.co.uk/what-is-co-housing.html

>

http://www.vivariumtrust.co.uk/what-is-co-housing.html


ASPIRATIONS AND DRIVERS

Maintain or reduceexpenditure on residential careand/or hospital admissionsand facilitate hospitaldischarge through increasingcare and support in thecommunity.

Encourage greater planningfor old age, and in particularplanning a move to moresuitable housing.

Respond to the needs of themany older people who, oncurrent projections, willdevelop dementia.

Deliver social housing within aconstrained and decentralisedfunding environment.

IMPLICATION FOR COMMISSIONERS AND PROVIDERS

All new developments should be capable of having the range of health and care services being delivered into them to ensure that they can remainlifetime homes, eg, supporting reablement, intermediate care, and end of life care.

Well designed housing options for older people will reduce the level ofadmissions into residential care for housing related reasons. It will alsopromote improved health, such as reducing falls and fractures, which in turn will lessen the demand for care services.

Housing suitable for older people should focus on design that facilitateshealth and well being, eg, removal of trip hazards, good lighting to assistpeople with visual impairments, have wiring and trunking designed intobuildings to assist telehealth and telecare if needed in later life.

It is unclear the degree to which housing choice influences decisions aboutmoves in later life, but evidence from other countries, such as theNetherlands and Denmark, suggests that more people will consider a moveif there are attractive housing options available. Visioning different types of housing developments could be a useful role that Councils could take on in partnership with developers. Offering assistance and physical help with moving may be particularly important in helping people to make amove in older age.

The main focus for specialist housing for older people has been on thosewith physical rather than mental frailty. Commissioners and providers needto address the design and delivery issues to maximise the opportunities forpeople with dementia to remain in housing in the community.

Proposals to change the housing benefit system for supported housing,alongside changes to Supporting People funding, mean providers andcommissioners will need to work together to ensure services are affordablefor older people, as well as financially viable.

There is no longer a dedicated funding stream to support the developmentof extra care housing and so commissioners and providers need to worktogether to find alternative approaches which maximise the benefit of anypublic grants still available. This is likely to involve exploring the potential toinclude rented property within developments primarily for sale.

SECTION A, PAPER A2

Understanding local demandfrom older people forhousing, care and support

This briefing paper forms part of Section A of the StrategicHousing for Older People Resource Pack. Section Adiscusses the wider policy context of housing for olderpeople, and how we might better understand demand and supply in the market.



10 SECTION A: PAPER 2 Understanding local demand from older people for housing, care and support

11 HM Government (2009). Building a society for all ages.

12 Department of Health (2010). Healthy Lives, Healthy People: Our Strategy for Public Health in England.

13 Department for Communities and Local Government (2008). Lifetime Homes, Lifetime Neighbourhoods: A National Strategy forHousing in an Ageing Society.

14 The Marmot Review (2010). Fairer Society, Healthy Lives: Strategic Review of Health Inequalities in England post-2010.

15 Office for National Statistics (2010). Pension Trends.

16 Data from the Pensions Policy Institute.

Introduction

The key facts below illustrate a number of different trends concerning thepopulation of older people in England. It shows a population that is living longerand has greater affluence than its predecessors but for some reveals problems ofpoverty and poor health for many more. It is this complex interaction of factors thatmakes it hard to translate demographic change into anticipated housing demand.This paper explores some of those complexities of need and desire that willinfluence demand and suggest some approaches that may be adopted. Further helpcan also be obtained from the Tools at the end of this section.

KEY FACTS – DEMAND

DEMOGRAPHY: In 2010 the population aged 65 and over was estimated as being eight and a halfmillion, by 2030 it is thought it will reach nearly thirteen million. In 2007, for the first time ever, thenumber of people in the UK aged 65 and over was greater than the number of children aged under1611. Life expectancy is expected to continue to rise for both men and women reaching 81 and 85years of age respectively by 2020 with the life expectancy for men increasing at a faster rate thanthat for women12. By 2030 there will be a larger but still relatively small number of older people fromblack and minority ethnic groups; there is likely to be a doubling of the number of older disabledpeople and an increase in the number of older people with learning disabilities.

POPULATION DISTRIBUTION: By 2029 projections show that 36% of the population in the most rurallocal authority districts will be aged over 60, compared to just 23% in the most urban. By 2029 thepopulation aged 75 years and older is projected to rise by 47% in urban areas, but by 90% in ruralareas13. The average difference in disability-free life expectancy is 17 years14. For example, TowerHamlets is predicted to face a growth in its over 80s population of just under 5% over the next twentyyears, whereas Herefordshire will have a growth in the same age group of over 100%. In Herefordshireby 2030, the population aged 65 and over, will make up a third of the total population of the county.

WEALTH: Average gross pensioner incomes increased by 44% in real terms between 1994/95 and2008/09, ahead of the growth in average earnings15. 59% of older people receive an occupationalpension as compared to just 13% prior to 194516. In 2008/09, pensioner couples in the highest

SECTION A: PAPER 2 Understanding local demand from older people for housing, care and support 11

income quintile received median net incomes of £755 per week, compared with £197 per week forthose in the lowest income quintile. It was also estimated in the same year that 1.8 millionpensioners in the UK were living on less than 60% of equivalised contemporary median income afterhousing costs – the most commonly used official measure of poverty – compared with 2.8 millionpensioners in 1999/200017. However, people living in the poorest neighbourhoods will on averagedie seven years earlier than people living in the wealthiest neighbourhoods.

HOUSING: 76.1% of people aged 65-74 are living in property that they own18. The value of housingequity held by older people in the UK has been estimated as ranging from £751 billion19 to £3trillion, which even at its lowest estimate means around £83,000 for every person aged 65 and over.Yet many older people live in housing that is less than suitable, either because of the poor fabric ofthe property or its unsuitability for someone who is older and has a disability. It is estimated that athird of older people live in non-decent or hazardous housing. The impact of this can be seen forexample in older people who fall. Injuries from falling are estimated to cost the state over £1billion a year – one in four falls involve stairs, and the majority take place in the home20.

HEALTH: In the UK, like many western societies, the key issue has been our inability to compress the periodof morbidity or ill-health people suffer prior to death. It drives up demand for care services but especiallydemand for health. For example, falls and resultant fractures in people aged 65 and over account for over 4 million bed days each year in England alone. The healthcare costs associated with fragility fractures isestimated at £2 billion a year and injurious falls, including over 70,000 hip fractures annually, are the leading cause of accident-related mortality in older people21. However, demand for health services are alsoinfluenced by poor health sector performance. In England, fewer than 40% of trusts are achieving theminimum standard on stroke care. Even in the best region, only just over half of trusts achieve the minimum standard, and in the worst (the East of England), only 29% of trusts achieve the standard22.

THE COSTS OF AN AGEING POPULATION: If state funded care service provision were to be simplyincreased in proportion to population growth, public spending on care services would need to doublebetween 2010 and 2026.11 Older people accounted for nearly 60% of the £16.1 billion grosscurrent social care spend of Local Authorities in 2008/0923. Dementia costs the UK economy £17billion a year; in the next 30 years the number of people with dementia in the UK will double to 1.4 million, while costs could treble to over £50 billion a year24. 12% of people aged 16 or over inEngland in 2009/10 were looking after or giving special help to a sick, disabled or elderly person.This represents around 5 million adults in England25.

17 Office for National Statistics (September 2010). Pension Trends, Chapter 13: Inequalities and poverty in retirement.

18 Data from Projecting Older People Population Information (POPPI) system.

19 Data from Key Retirement Solutions Equity Release index which tracks the amount of equity held in property by people over 65 yearsof age in Great Britain. Figures are based on analysis of data from; the Office for National Statistics Family Spending Report (2009);the Land Registry House Price Index; Registers of Scotland House Price Statistics; and ICM (2010).

20 Care & Repair, England (2006). Small things matter: the key role of handyperson services.

21 Royal College of Physicians (2011). Falling Standards, Broken Promises, Report of the national audit of falls and bone health in older people 2010.

22 Care Quality Commission (January 2011). Supporting life after stroke – A review of services for people who have had a stroke andtheir carers.

23 Housing LIN (2010). Rural Housing, Older People and the Big Society.

24 Audit Commission (2010). Under Pressure: Tackling the Financial Challenges for Councils of an Ageing Population.

25 Health and Social Care Information Centre (2010). Survey of Carers in Households in 2009/10.

The complexities ofpredicting demandPredicting what the public will want and expectis a far from easy task. This is not only in termsof housing, but for any commodity, given thatdemand can be driven as much by marketingand advertising as by need. In the case of olderpeople and demand for housing and care, it isthe sheer size of demographic growth thatcommentators seize upon as equating withneed, making the simple but erroneousjudgement that growth will automatically bereflected in equivalent dependency.

However, knowing the pace and scale of theincrease in the numbers of older people is not thesame as being able to predict demand for particulartypes of accommodation or services and, within thatdemand, who may or may not be dependent onstate provision. This is particularly true in assessingdemand for relatively new types of provisionwhich most older people may not have come acrossor have experienced, such as housing with care.Demand for any particular type of housing islikely to be influenced by a plethora of factors:

LONGEVITY: There are basically three schools of thought concerning long-termpopulation growth.26

• The first suggests that the populationthroughout history has continued to increase inlongevity and therefore will continue to do so.

• The second view is that longevity has peaked and due to deteriorating diet and a lack of exercise, long term healthconditions will mean some populations begin to die younger.

• The third (and as many might argue, themost problematic) is that the population willcontinue to live longer but with an increasingproportion of people suffering multipledisabilities, as medicine becomes better atkeeping people alive but not cured.

DRUGS AND TREATMENTS: Demand forprovision may be heavily influenced bytreatments available. At the turn of the lastcentury people died from very differentconditions from now such as, for example,tuberculosis. At the forefront of current thinking is the potential for a cure for dementia using stem cell research where theemphasis is on either getting the stem cellsalready naturally present in the brain to replace the cells destroyed by dementia, orputting new stem cells into the brain, gettingthem to replace the cells destroyed bydementia. However, poor performance by the health service in areas such as falls27,strokes28 and continence29 may alternativelyincrease the level of dependency and hence the demand for specific types ofaccommodation and for care and support.


26 See, for example, Howse K (July 2006). Increasing Life Expectancy and the Compression of Morbidity: A Critical Review of theDebate, Oxford Institute of Ageing.

27 Royal College of Physicians (2011). Falling Standards, Broken Promises, Report of the national audit of falls and bone health in olderpeople 2010.

28 Care Quality Commission (January 2011). Supporting life after stroke – A review of services for people who have had a stroke andtheir carers. Royal College of Physicians (May 2011). National Sentinel Stroke Audit 2010, Round 7, Public Report for England, Walesand Northern Ireland.

29 Healthcare Quality Improvement Partnership and Royal College of Physicians (September 2010). National Audit of Continence Care.

“Almost a quarter of Brits will be agedover 65 in 20 years’ time — heaping a

massive burden on the taxpayer. Shock projections reveal by 2031 there

will be 5.6 million more people overthe current retirement age”.

‘Ancient Britains’, The Sun newspaper, 2010.

ACCESSIBILITY: Clearly availability of provisionand people’s knowledge of what is available,impacts on the take-up of services. Equally, ifservice availability in a given area diminishes orincreases then take-up is also likely to diminishor increase in equal proportion. For example, ifthe size of residential care homes increase andhence unit costs fall, take-up is likely to increase,even though residential care is not seen as theoption of choice by most people. Price for somecare services may also increasingly become afactor in influencing take-up.

Alternatively, if people have not heard aboutextra care housing, or cannot accessinformation, then demand for provision is likelyto be low. One local authority stated thatdemand for extra care housing was low asnobody identified such accommodation in theirhousing needs survey. However, as they had noextra care housing within their authority it isquite likely that people had no perception ofwhat could be available and hence were hardlylikely to choose it as an option.

WEALTH: Wealth influences demand in avariety of ways. Clearly there is a strongrelationship between health and wealth, given

that in poorer areas people die younger than in more affluent areas. It can influence demand for housing in terms of people havingproperty for sale. It will influence the balancebetween state funded care and that whichpeople fund themselves.

People’s attitudes to how they spend theirmoney are also a factor. Older people may wellsee the purchase of a property as a financiallysound use of their housing asset yet be resistantto paying for their care.

ATTITUDE TO RISK: People’s attitude to risk,whether amongst family members orprofessionals, will impact on demand for whatare perceived as ‘riskier’ service options.

In particular, clinicians’ beliefs about what forms of care are appropriate after hospitaldischarge will impact on demand for servicesoutside of ‘the favoured’ or more traditionalpathway. For example, residential care might be marketed to anxious relatives, as offering‘safety’ or ‘peace of mind’.

INFORMATION: The extent of information aboutthe services that are available and the outcomesthose services are seeking to achieve will impact ondemand30. Lack of information will restrict thechoices older people can make. Equally informationin an inaccessible format will have the same effect.Inaccessibility may be in terms of language, in alack of publicity or in format and style.


“....The research suggests that there isvery low awareness of how care and

support are funded, although people dobelieve that caring for older people is a

priority. People do not feel well-informed, meaning that very few people

are planning to save for future careneeds. Furthermore, findings indicate thatpeople are often unable to distinguish

between social care and health services.”

Department of Health (2011). Fairer Care Funding:Analysis and evidence supporting the recommendations

of the Commission on Funding of Care and Support.

“Demographic factors ... (such as ahigher proportion of residents with

dementia) point to an increasingreliance on relatives and representatives

in the decision-making process.”

Office of Fair Trading (2011). Evaluating the impact ofthe 2005 OFT study into care homes for older people.

30 All Party Parliamentary Group on Housing and Care for Older People (2011). Living Well At Home Inquiry.

What accommodationdo older people want? The Wanless Review, ‘Securing Good Care forOlder People’31, offered an analysis of people’spreferences for housing and care as the tablebelow shows. It illustrated that whilst there isa clear preference by older people to remain intheir family home, many older people contemplatea move to alternative accommodation, althoughfew people wish that to be residential care.

PEOPLE’S PREFERENCES %SHOULD THEY NEED CARE:

Stay in my own home with care and support from friends and family 62

Stay in my own home but with care and support from trained care workers 56

Move to a smaller home of my own 35

Move to sheltered housing with a warden 27

Move to sheltered housing with a warden and other social care services such as hairdressing and organised social outings 25

Move in with my son or daughter 14

Move to a private residential home 11

Move to a local council residential home 7

Move to a residential home provided by a charitable organisation 3

None 1

Don’t know 2

Such preferences are clearly not absolute but may be influenced by the choices that are on offer or indeed the perceptions peoplehave as to what is available or is suitable. For example in the Netherlands32, where there is a wider choice of specialist accommodationfor older people, the numbers wishing to moveto alternative accommodation is greater than in the UK.

The numbers of people wishing to remain intheir family home may be heavily influenced bylimited choice rather than by a real preference.People’s views and opinions are also heavily


31 Wanless D (2006). Securing Good Care for Older People: Taking a long-term view. King’s Fund.

32 VROM (2002). Housing for the elderly in the Netherlands.


influenced by what they believe to be true orwhat they are told by professionals as thediagram above illustrates.

However, when the question is asked aboutwhat are the characteristics of good qualityaccommodation for older people then althoughbound by people’s knowledge of existingprovision, people are clear about their desires. It comes as no surprise that older people’s housingpreferences in some respects are no different fromother people’s: to live in a nice neighbourhood,to have accommodation that looks good and tohave friendly neighbours. There is also a strong

preference for it to be housing that has lowmaintenance costs and is easy to look after.

It could be argued that, in terms of the overallhousing market, if there is a demand for newtypes of housing then surely the market willrespond to that need as and when it arises.However, in reality there are a number ofproblems with such an approach:

• In terms of the timescales involved inplanning and funding specialist housingdevelopments (often 2 – 5 years), it is simplynot possible to wait for need to emerge and then put in place what people require.

FACTORS THAT PUSH TOWARDS REMAINING WITHIN THE COMMUNITY:

FACTORS THAT PULL TOWARDSA MOVE INTO RESIDENTIAL CARE:

“My GP/consultant/family think I would be better off in residential care”

“I have been told I’m unlikely to get any better”

“I don’t feel safe at night in our neighbourhood”

“My house feels unmanagable”

“There are no shops, post offices or banks nearby”

“The expectation of professional services isthat I will return home with support”

“I have been told there is no reason I should not improve”

“My property is easily observed front andback, it’s a quiet area and I have good

neighbours”

“I can access good help with repairsand maintenance”

“I have been amazed at the different types of help on offer to me and I know I can always get

the right ammount of help when I need it.”

“The local shopping centremeets all my needs”

“I don’t think home care could meet my needs, and they always used to tell

me how busy they were”

Housing with care on site involves greaterup-front costs than ordinary housing andhence is a higher risk for any developer.

• If provision is not available inevitably peoplefall back onto an institutional response ofhospital and residential care (where there is already spare capacity if not the desire tooccupy it). Often a housing move isprecipitated by a crisis when people are ill. So inevitably the choice comes down to what is available.

• Most people are not good at predicting what will happen to them in old age, oftenbelieving that physical or mental incapacity is something that happens to other peopleand hence their future plans are not likely to take this into account.

Yet from the perspective of national wellbeingthere are many good reasons for promoting the development of a wide range of housingsuitable for older people. Good housing reduces the demand for care and support and improves people’s health. It can delivereconomies of scale when care is needed. It frees up family housing given that the highest levels of under-occupancy are amongstolder people. Finally, given the widespreadencouragement of home ownership, it offers a‘win-win’ approach to provision, given that it isone way in which people can readily contributeto their health and well-being, whilst at thesame time retaining their housing equity.


“Bungalows are popular, as are houses;while ground floor access is preferred

for mobility reasons, some researchfound this had disadvantages in termsof security, so ground floor properties

are considered least satisfactory. Forthose who could manage stairs, upperfloor flats are sometimes preferred for

security and quiet.

Fuel poverty and poor insulation still emerge as significant issues in

much research.

Space is considered important; thisincludes space for hobbies, to havefamily and friends to stay, and for

couples to have space independent fromeach other. A large property was not

considered problematic in itself, thoughthe ability to heat or maintain it may

be an issue. This is particularly important,given the increased time spent on home-based leisure activities by those over 65.

Safety and security are important, and while this may relate to fear

rather than reality, it should be takeninto account during the design of

new developments.

Well designed kitchens and bathroomsare important, and should have space for

wheel chairs or mobility equipment.

Shops, services and public transportshould be within easy access.

Good neighbours are important, andtheir age was only found to be a

slight concern.

An open outlook is also popular, towatch others come and go.”

Scottish Executive Social Research (July 2006). Time toMove? A Literature Review of Housing for Older People.

USEFUL RESOURCE

See Tools A1 and A2 for help inreviewing future needs and expectations amongst older people.

Developingprojections of demandTherefore, predicting future demand forparticular types of housing is as much an art asit is a science. Baseline data can show likelyfuture population trends, the number of owneroccupiers, and the likely prevalence of certainconditions. Data about existing choices canshow how demand for sheltered housing orresidential care changes over time. However,people’s desires and wishes also need to beunderstood and factored into the equation. Ashas already been stated give people few optionsand they are likely to remain in their traditionalfamily homes even with a high degree ofdiscomfort. Show attractive and affordablealternatives that match peoples desires and theyare much more likely to opt for change.

Consumer led approachesA number of local authorities and housingproviders have begun to use structured focusgroup discussions with immediate pre-and postretirement populations to test the market. Forsome people even at 65 older old age mayseem a long way off, yet for others, particularlythose who have cared for their own olderparents, they may have very clear views of their future accommodation needs and alsowhat they might wish to avoid.

It is also possible to use example brochures of existing different types of specialistaccommodation to explore people’s potentialpreferences for where they might live and the price they might be prepared to pay forsuch accommodation.


Understanding existing use of accommodationMuch can be understood by exploring theexisting use of accommodation. Care homes arereferred to in more detail below but there isalso information to be gained from othersources, such as understanding the relationshipbetween sheltered housing and care homes. Forexample, which schemes seem good atsupporting people in the community and why,as compared to which schemes seem to hurrypeople into residential care prematurely? Whatare the potential numbers that could have beencared for in the community if existing forms ofaccommodation had been available? There isalso value in exploring the relationship betweenhome adaptations, cost and outcomes.Sometimes even expensive modifications maystill not be cost-effective, either in terms of thequality of life they deliver, or the potential toensure someone remains within the community.

Understanding hospitaladmission and discharge dataAlthough an area that is often overlooked in terms of understanding demand for housing with care, reasons for hospitaladmissions, and data on hospital discharge, can provide a rich source of information about the impact inappropriate or poor housing is having on the health of the olderpopulation locally, and hence the scale of thepotential demand for attractive, well-designedforms of specialist housing.

Two possible approachesNeither of the approaches described are exact, butthey can be used alongside other data to give atleast a baseline for estimating potential demand.

A) MODELLING THROUGH CARE HOME DEMAND

Although perhaps now a little dated, a paperpublished in 200433 estimated that about a thirdof the population entering a care home couldhave moved to a form of housing with care as aviable alternative, with a further third whocould have managed in such housing had theymoved at some time earlier in their care history.Thus if you were only considering how demandfor care home provision could be reducedthrough the delivery of extra care housing, thisevidence would suggest that at least one thirdof residents could have been diverted to moreappropriate housing with care, and possibly upto two thirds if appropriate information andadvice had been available. You would then alsoneed to consider the impact other interventionsin the community could have on this demand,such as the provision of telecare, aids andadaptations, and better information.

B) MODELLING FROM POPULATION DATA

There are a number of different models forestimating demand for supported housing.“Housing markets and independence in oldage”34 offers one model. A more detailedapproach is available in ‘The Older Persons’Housing Toolkit’35 although the assumptions onwhich it defines its prevalence rates are notincluded in the paper.

33 Kerslake A and Stilwell P (2004). What makes Older People choose Residential Care and are there alternatives? Housing Care and Support; 7 (4): 4-8.


35 Appleton, N, in McCarthy and Stone (forthcoming). The Older Persons’ Housing Toolkit: Helping local authorities plan for specialist housing for older people


FORM OF PROVISION ESTIMATE OF DEMAND PER THOUSAND OF THE RELEVANT 75+ POPULATION

Conventional sheltered housing to rent 60

Leasehold sheltered housing 120

Enhanced sheltered housing (divided 50:50 between that for rent and that for sale)36 20

Extra care housing for rent 15

Extra care housing for sale 30

Housing based provision for dementia 6

Therefore, as a baseline, it is possible toextrapolate crude estimates of future demand from existing data. However, the result is likely to be heavily influenced by the range of services and accommodation that is offer.

36 Defined as provision with some care needs.


USEFUL RESOURCE

See Tools A2 and A3 for help inidentifying sources of data andapproaches to exploring older people’s preferences.

Key messagesThe older people’s population is going tosignificantly increase over the next twentyyears with the oldest old group, and hencethat most likely to need support, growingfaster than the rest of the population.

The disparity between the richest group andthe poorest is wide, although comparativeaffluence in older age is increasingsubstantially due to housing equity andoccupational pensions.

The older people’s population and its wealth is not distributed equally around the countryand often not equally within any one localauthority area.

Predicting future demand for housing withcare services is subject to a large number ofvariables, but there is a good case for farmore consumer research of what older peopledo and do not want from accommodation inolder age. To gain an accurate view suchstudies need to be aspirational, not a reviewof current stock and choices.

Local authority planners and commissionersneed to be clear about the volume of housingsuitable for older people that might be needed,and where that can be located. In addition,they need to engage more effectively withprimary health care and hospital to identifymore integrated approaches across housing,health and social care for older people.


SECTION A, PAPER A3

Understanding the localmarket for older people’shousing, care and support

This briefing paper forms part of Section A of the Strategic Housing for Older People Resource Pack. Section A discusses the wider policy context of housing for older people, and how we might better understanddemand and supply in the market.



Exni

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, New

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22 SECTION A: PAPER 3 Understanding the local market for older people’s housing, care and support

37 The first recorded Almshouse was founded by King Athelstan in York in the 10th century AD. The oldest charity still in existence is thought to be the Hospital of St. Oswald in Worcester, founded circa 990.

38 Homes and Communities Agency (2009). Housing our Ageing Population: Panel for Innovation (HAPPI) report.

39 Ibid.

40 Office for National Statistics (2010). Focus on Older People: Housing.

41 Ibid

42 Department for Communities and Local Government (2008). Lifetime Homes, Lifetime Neighbourhoods: A National Strategy for Housing in an Ageing Society.

Introduction

The provision of specialised housing for older people dates back to the Middle Ages withthe development of Almshouses37. Since then provision has moved from trade-basedcontinuing care communities through to the significant development of sheltered housingfollowing the Second World War. Sheltered housing was seen as part of a continuumsitting between general needs housing and the higher care provided in residential carehomes. Most recently there has been a shift towards services that enable people toremain within their own homes, ideally homes which have been designed to promoteindependence. This paper explores the approach needed to understand and develop thismarket to meet the changing needs and expectations of older people into the future.

KEY FACTS – SUPPLY

TYPES OF HOUSING: There are approximately 19.6 million units of general needs affordable housingin England, of which 5.8 million accommodate pensioners, and there are just under 730,000 units ofspecialised housing38. Only a minority of older people live in sheltered housing, even amongst thoseaged over 85 years. More than half (476,000) of the specialised housing units are shelteredaccommodation; less than 40,000 are extra care housing39.

OWNER OCCUPATION: The majority of older people households are owner-occupied. The prevalenceof owner occupation increases the younger the population gets, for example of those aged 85 andover, 61% own their property whereas for those aged 65 to 74 the proportion increases to 76%40.

SOCIAL HOUSING: A fifth of older people households are in social housing whilst only one in 20 are inprivately rented housing. The proportion of older people households that are in social rented accommodationincreases with age. Among those households where the household reference person is aged 50 to 64, 16%are social renters. This increases to 22% for those aged 65 to 84 and to 32% for those aged 85 and over41.

PRIVATE SECTOR HOUSING: Most vulnerable older households are in the private sector. Around40% of private sector vulnerable households currently in non-decent homes are outright owners butoften have little disposable income to use to modernise or repair their homes42.

SECTION A: PAPER 3 Understanding the local market for older people’s housing, care and support 23

43 Care Quality Commission (2011). The state of healthcare and adult social care in England: an overview of key themes in care in 2010/2011.

44 Care Quality Commission (2011). The state of healthcare and adult social care in England: an overview of key themes in care in 2010/2011.

45 European Commission (2010). ICT & Ageing: European Study on Users, Markets and Technologies.

46 Carers UK (2007). Valuing carers – calculating the value of unpaid care.

47 Help the Aged and Age Concern (2009). One Voice: Shaping our ageing society.

48 Department for Communities and Local Government (2011). Supporting People Local System Data: Quarter 3 (Financial Year) 2010.

49 Department of Communities and Local Government (2009). The future Home Improvement Agency: Handyperson services report.

50 Department of Communities and Local Government (2009). The future Home Improvement Agency: Handyperson services report.

51 Department for Communities and Local Government (2009). Research into the financial benefits of the Supporting People programme.

52 Ibid.

53 Homes and Communities Agency (2010). Financial benefits of investment in specialist housing for vulnerable and older people.

CARE HOMES: As at July 2011, there were 4,608 care homes with nursing (providing 208,546 beds)and 13,475 care homes without nursing (providing 261,262 beds). An estimated 45% of care home places in England are occupied by people who are self-funding rather than being paid for by thestate. The number of residential care home services fell by 10% between 2004 and 201043.

HOME CARE: There were 5,894 registered home care agencies in England as at July 2011, with thehighest number in the South East, followed by the North West and London, and the lowest numberin the North East. The majority of these (74%) provide services for older people. The number ofagencies has increased by a third between 2004 and 201044.

ALARM CALL SYSTEMS: There are an estimated 1.5-1.6 million people using some form of socialalarm in the UK, representing about 15% of those aged 65 years or older45.

UNPAID CARE: The over 50s age group is the source of over half of unpaid care, the total value ofwhich was estimated in 2007 to be £87 million46. 12% of those aged 65 or over say they feel theyare trapped in their own home47.

COMMUNITY ALARM SERVICES: there were 1,715 community alarm services identified acrossEngland as at quarter 3, 201048.

HOME IMPROVEMENT AGENCIES: there were 339 home improvement services recorded acrossEngland as at quarter 3, 201049. There are estimated to be 230 individual HIA agencies.

HANDYPERSON SERVICES: the availability of handyperson services has increased across the country, but they are not yet available in all areas. Some 180 HIA agencies report offering services or elements of services50.

BENEFIT REALISATION (REVENUE): an estimate of the net financial benefit (revenue) from providing£32.4 million worth of housing related support to older people in very sheltered housing (extra carehousing) is £123.4 million51. An estimate of the net financial benefit (revenue) from providing £198.2million worth of housing related support to older people in sheltered housing is £646.9 million52.

BENEFIT REALISATION (CAPITAL): An estimate of the benefit realisation (capital) of the £1,178.9million investment in specialist housing for older people in 2008/9 and 2009/10 (where on average41% was funded by the HCA) is £219 million, equivalent to £444 net benefit per person per year53.

“Older people’s housing will only be apriority for investment if the need for itis identified in local and regional strategies;

but commissioners have found itchallenging to integrate the evidence

base for health, housing, care and supportat both local and regional levels.”

National Housing Federation (2010). In Your Lifetime:A vision of housing, care and support for an ageing society.

“Providers have to have a goodunderstanding and knowledge of thisspecialist market in order to succeed.These are necessary in all aspects of

the business: land assembly andplanning, design, specification, finance,marketing and sales, and in the settingup of the continuing client service and

maintenance operation.”

Ball M (2011). Housing markets and independence in old age: expanding the opportunities.

Henley, University of Reading.

A changing marketMore recently, and particularly since the 1980s,the traditional model of sheltered housing hasfaced a series of challenges: increasedexpectations, for example around theacceptability of bedsits and shared facilities, ashift towards supporting people to remain intheir own homes (including within shelteredhousing) as their care and support needsincrease, an emphasis on creating a ‘home forlife’ and reducing admissions to care homes,and difficulty letting poorly designed or poorlylocated housing.

The response has been to develop new types ofhousing which are well designed, provide a rangeof care and support services, and can meet theneeds of more frail residents. There are abewildering array of names for such developments,eg, very sheltered, assisted living, retirementhomes, retirement villages, extra care, housingwith care, flexi care and close care. Despitethese developments older people still face achoice which is limited in terms of tenure,affordability, location and service design.

The need for a localstrategic approachThe need for a cross-agency strategic approachhas been given a strong emphasis by a range ofgovernment and national bodies54. The problemis that housing tends only to be seen in termsof a planning or housing department issuewithin many local authorities. Therefore, healthcommissioners may not see the gain to be hadfrom new housing suitable for older people;social care may not understand the requirementsand approaches of the planning authority.

Yet developing a range of housing suitable forolder people with a variety of needs involvessocial care, health and supporting people bothin terms of the resources it consumes and thefinancial and human benefits it might deliver. Italso needs to straddle different forms of tenureand particularly owner occupation.

As stated elsewhere, without better owner-occupied housing in the community, the choice for older people who are home owners may often be between “getting by” in unsuitable accommodation, or up-rooting to some form of institutional care in unfamiliar surroundings.

54 See, for example: All Party Parliamentary Group on Housing and Care for Older People (2011). Living Well At Home Inquiry.


“Councils and their partners need tounderstand their local context regarding

care and support needs, and therelative supply position, if they are to

develop a diverse range of high qualityprovision that people want.”

ADASS et al (2010). Think Local, Act Personal: NextSteps for Transforming Adult Social Care.

“The Market Position Statement is theproduct of the Council’s work so far to

bring together a range of informationabout the market into one short and

easily accessible document. It acts as acalling card to the market, by stating the

Council’s understanding of the localsocial care and support market as well as

setting out how it intends to behavetowards the market in the future. It

represents the start of an ongoingdialogue between the Council, people

with care and support needs and existingand prospective providers of care andsupport in the District. It summarises

key messages about demographictrends and population needs and their

projected impact on demand. It alsoincludes information about the currentrange of supply; including cost, quality

and recent expenditure.”

Bradford Metropolitan District Council.www.bradford.gov.uk/bmdc/health_well-being_and_care/adult_care/related_information/market_development.

Therefore, bringing developers and funders intolong term strategic partnerships with the healthservice and local authority, whether they areregistered social landlords, voluntary organisationsor independent sector providers, is important.

Reviewing the marketWhether from the point of view of acommissioner of services, a developer or a provider, there needs to be a goodunderstanding of the market by all parties.

Gaining such an understanding is likely torequire answering questions such as:

• How is the local market structured, forexample in terms of size, value, users?

• Who are the key players in the market place,and what products and services do theyoffer? What is the quality of services onoffer? What is competition like in this area?

• What related services are provided whichcould impact on demand?

• What is the current capacity and capability in the marketplace?

• What are the drivers behind the market?

• What business opportunities are regarded as most desirable? What is the scope forinnovation and expansion in the market?What price for different types ofaccommodation might the market bear?

There are a number of documents required at alocal level which should encapsulate thisinformation and make it publicly available. Theseinclude Strategic Housing Market Assessments,Local Investment Plans and Local DevelopmentPlans, Joint Strategic Needs Assessments, andincreasingly local Market Position Statements.


“Councils have a role in stimulating,managing and shaping this market,supporting communities, voluntary

organisations, social enterprises andmutuals to flourish and developinnovative and creative ways of

addressing care needs.”

Department of Health (2010). A Vision for Adult Social Care.

http://www.bradford.gov.uk/bmdc/health_well-being_and_care/

On the latter the suggestion is that the localauthority takes the lead but moves away fromlengthy and sometimes highly descriptivecommissioning strategies. Instead the JointStrategic Needs Assessment should reflect thehousing needs of the older people populationand in terms of supply then a succinct MarketPosition Statement, developed by the localauthority but for the market, should help toprovide the necessary overview.

A Market Position Statement should be adocument which describes the local authoritiesintentions towards the market, taking intoaccount its current size, shape and performance,and how new forms of accommodation suitablefor older people can be driven forwards.

Other characteristics of a Market PositionStatement are that it should:

• Cover the whole market, ie, not just theelement that the local authority funds.

• It should be market facing, ie, containinformation the authority believes, and cansubstantiate, would be of benefit to providers.

• Indicate how the local authority intends tobehave towards the market in the future.

• Be a brief analytic rather than descriptive, document.

• Be knowledge based in that each statement itmakes should have a rationale that underpinsit, whether through population estimates,market surveys, research, etc.

Reviewing sheltered housing Given that the current stock of shelteredhousing is probably the highest value assetpredominantly owned for older people in thepublic domain, then the quality of that stockand how that asset is used is critical. Oncespent there is unlikely again to be aninvestment of equivalent value.

Yet housing is vital to ensuring theindependence and social inclusion of peoplewho are vulnerable or disadvantaged as a result of their age, ill-health, disability orcircumstances. Inaccessible or inappropriatehousing can significantly reduce the ability of people who have ill-health or a disability tolead good quality lives, and in many cases is adirect contributor to unnecessary entry intoinstitutional care. In seeking to provideaccommodation for older people, shelteredhousing should be appropriate to needs,promote independence, offer full accessibilityand, as far as possible, provide a home for lifefor its residents. It should not be a steppingstone on the pathway to residential care.

Although many sheltered housing providers are reviewing their stock, few local authoritieshave the same level of information about theirlocal market as a whole55. In addition, current

USEFUL RESOURCE

See Tool A2 for a range of useful datasources in understanding the market,and Tool A6 for help for thedevelopment of a Market Position Statement.

“476,000 of specialist housing unitsfor older people are sheltered

accommodation; less than 40,000 are extra care housing.”

Homes and Communities Agency (2010). Housing ourAgeing Population: Panel for Innovation (HAPPI) report.


55 Department for Communities and Local Government (2010). More than just a few kind words: Reshaping support in shelteredhousing: A good practice guide for housing providers and local authorities.

stock assessment methods may not go farbeyond measuring volume and take up as awhole, including the wider leasehold retirementhousing market.

Whether the stock is in the private sector, held by Registered Social Landlords/housingassociations, or by the local authority, there is, as a part of reviewing supply, a need toexplore how this might meet future housingneed. This could entail reviewing quality(projection of long term maintenance costs),accessibility (whether the whole scheme iswheelchair accessible), value (land andproperty), location (proximity to neighbourhoodfacilities) and tenure (is this for all sectors ofthe community?).

Reviewing thepathways to careFor the local authority it will be important tohave a good understanding about whatproportion of the total housing with caremarket may act as an alternative to residentialcare, given that local authorities have beenchallenged to develop preventative measuresthat can defer or delay people needing longerterm care56. Clearly the long term role ofsheltered housing and using that resourcewhen modified to deliver quality housing, into which the full range of care, support and health services can be delivered, is likelyto become the focus of a number ofpartnership arrangements57.

However, the key task here is knowing whatlevel of investment by the local authority andby the health service will deliver a return interms of reduced hospital admission and/or in terms of reduced admission to care homes aspart of their locally agreed Quality, Innovation,

“The majority of sheltered housingstock was built in the 1950s, 1960sand early 1970s when a philosophy

prevailed that an older person wouldlive in low-support housing for a

limited period of time before movingto residential care as their support needs increased.”

Local Government Group (2010). Good homes in which.

USEFUL RESOURCE

See Tool A4 for a description of the keyissues in assessing sheltered housingand potential sources of information to support appraising options and investment decisions.


56 Department of Health (2009). Use of Resources in Adult Social Care.

57 See also: Chartered Institute of Housing (2009). Housing, Health and Care: A policy and practice report.

Productivity and Prevention (QIPP) agenda58.Only by making that estimate can local Healthand Wellbeing Boards determine the level ofinvestment they might wish to make inhousing-based approaches. Some of this workcan be done through reviewing past cases anddetermining which conditions may be divertedor alleviated through a housing-based response.

Housing with care and support is, in general, lowerin cost to local authorities than residential care,although this may depend on the level of capitalborrowing required to fund new schemes and onthe criteria for admissions to schemes59.

Reviewing communitybased servicesWhether people live in traditional familyhousing or have made a move to housing moreappropriate to their needs, many will accessthe range of community based services.

What these services cost and how they areconfigured will have a profound impact onpeople’s ability to remain within the community.

Certainly, maintaining people in their traditionalfamily home does not always mean low cost.For any one individual, services may include:home care, meals services, care and repair,community alarm, installation of aids, handyperson services, housing adaptations, districtnursing, floating warden support, psychiatricnursing, physiotherapy, occupational therapy,podiatry and community bathing services. Suchservices may be supplied by a range of agenciesacross the independent, state and voluntarysectors, and some may be charged for whilstothers are not. It is therefore of little surprisethat many older people get confused by theircare and support arrangements.

Given the range of provision there also tends tobe little monitoring of the impact of any singleapproach or configuration of services where


58 The NHS have adopted a Quality, Innovation, Productivity and Prevention (QIPP) approach to improving efficiency and quality throughthe transformation of services. Further information is available at: www.dh.gov.uk/en/Healthcare/Qualityandproductivity/QIPP/index.htm

59 Joseph Rowntree Foundation (2008). Costs and outcomes of an extra care housing scheme in Bradford.

“When matched with a group ofequivalent people moving into

residential care, costs were the same orlower in extra care housing. Better

outcomes and similar or lower costsindicate that extra care housing appears

to be a cost-effective alternative forpeople with the same characteristics who

currently move into residential care”

Personal Social Services Research Unit (July 2011).Improving Housing with Care Choices for Older

People: An Evaluation of Extra Care Housing.

“Most homes and communities have notbeen designed to meet people’s changingneeds as they get older. Inclusive housingand wider environmental design is key to

people’s health and well-being, and thesuitability of the built environment playsa critical role in the provision of socialcare and health services. Planning homesand neighbourhoods to take this major

demographic change into account istherefore central to all housing provision,

mainstream and specialist alike.”

Homes and Communities Agency. http://old.homesandcommunities.co.uk/vulnerable_people

http://old.homes

http://www.dh.gov.uk/en/Healthcare/Qualityandproductivity/QIPP/index.htm

there is an attempt to relate activity to cost tooutcome. For example, few local authoritiesseem to effectively monitor the impact of delaysin delivering equipment or undertakingadaptations on outcomes for service users. Oneregional study found that local housingauthorities set their budgets for DisabledFacilities Grants on the basis of demand inprevious years rather than on assessing needand the cost benefits the grant delivers60.

Similarly, the provision of home improvementservices more broadly can impact on publicexpenditure elsewhere: a report on the rolehousing can play in addressing healthinequalities cites an example of a reduction from£29,000 to £21,000 a year in home care coststhrough the provision of housing adaptations61.

Commissioners of services and those that seekto facilitate their local social care and housingmarket need to look at how they can introduceefficiencies through combining services;delivering integration at the point of service

delivery rather than just in managementstructures. It may also call for a far morerigorous understanding of cost benefit in orderto determine the relationship between cost,activity and outcome.

ReviewingneighbourhoodsIf health and care cannot deliver their objectivesof maintaining more people in the communitywithout suitable and appropriate housing beingin place then equally housing cannot deliver thatoutcome without people feeling comfortable andsafe within their communities andneighbourhoods. People wanting to stay in thecommunity means health and care services thathelp to deliver independence, housing suitablefor needs and which promotes well being andcommunities where people feel safe and secureand from which their needs can be met.

60 Joint Improvement Partnership South East (2011). Think Local, Act Personal and Housing – Making the connection: Providing disabledfacilities in the home.

61 National Housing Federation (2010). Invest in housing, invest in health.


Good neighbourhood design for older people62

can mean a variety of things, such as:

• Are health and care services grouped in theareas of highest density?

• Are there nearby shops and banks and areshops and banks accessible to older people,particularly those with mobility scooters?

• Are neighbourhoods considered safe, eg,what are the reaction times on street lightingfailure, is access to property safe and secure?

• Are transport systems accessible?

• Is there a structured plan for the installationof drop curbs.

• Are there verified and police-checked localcare and repair services?

• Is there easy access to a range of socialactivities and facilities?

Development of neighbourhoods that ‘work’ forolder people clearly involves far more than justhousing, health and care. Planning, leisureservices, libraries, and a plethora of voluntaryagencies and endeavours all have a part to playin creating and supporting communities thatolder people might wish to remain within.


62 Of interest is the Dutch model of ‘Woonzorgzones’. These are now being planned in about 30 neighbourhoods and villages all overthe Netherlands. The Woonzorgzones are geographical areas that offer round-the-clock care and a certain percentage of adaptedhousing within 200 meters walking distance of integrated service.

“From a local authority viewpoint, acommunity-orientation begins to

address a broad range of policyrequirements. These include providing

support for older and vulnerablehouseholds living in their own homes,

enhancing neighbourhood sustainabilityand promoting community cohesion.”

Keepmoat et al (2011). Housing an AgeingPopulation: The Extra Care Solution.

Reviewing planning guidanceThe use of the planning system is a keycomponent in ensuring the quality and supplyof an effective older person’s housing market,and extra care housing in particular. Anecdotally,many social care and health Leads have confessedthat a lack of links with, and understanding of,planning in the past has meant that olderpeople’s needs have not been considered orprioritised when planning applications or newhousing developments are considered.

More recently a number of policy documentshave specifically required that authorities ensureplanning policy takes into account the impact ofan ageing population. As the draft NationalPlanning Policy Framework sets out, localplanning authorities need to “plan for a mix ofhousing based on current and futuredemographic trends, market trends, and theneeds of different groups in the community(such as ... the elderly and people withdisabilities)”63. The government’s emphasis ondecentralised and local decision-making willmake it particularly important that

commissioners develop an ongoing workingrelationship with planners and local citizens.

There are a number of ways strategic commissionersneed to work towards ensuring that theplanning arrangements in their local authoritysupport the delivery of the agreed local visionfor housing suitable for older people64:

• Ensuring robust and up-to-date evidencereflecting older people’s needs is available tosupport planning decisions.

• Responding to consultation planningdocuments to ensure older people’s needsand preferences are reflected within them,and that they will support the delivery oflocal policy.

• Regularly consulting with and updatingplanners about local policy direction. Thereare three areas in particular where this islikely to prove helpful:

- Responses to planning applications for newcare homes and how to ensure they fit withthe local policy direction as far as possible.

- Supporting the development of new extracare housing schemes.

- Supporting the development of other formsof housing for older people as part of localregeneration mixed use developments.

• Ensuring there is a clear strategic approachsetting out local preferences in terms ofwhether a predominantly housing model orresidential care model is preferred65.

• Developing a clear approach to Section 106(or similar) applications in support of olderpeople’s housing.

• Development of pre-planning guidance forindependent and voluntary sector developerswhich outlines the local authority’s vision forextra care housing and older people’s


63 Department for Communities and Local Government (2011). Draft National Planning Policy Framework Consultation.

64 Royal Town Planning Institute (2006). Good Practice Note 8: Extra Care Housing: Development, planning, control and management.

65 See: Discussion re planning classes and their implications for planners and developers in Housing LIN (2011). Viewpoint: Planning useclasses and extra care housing.

“Planners are often missing from thetable in discussions about joined up

planning and provision of services forolder people ... more needs to be done

to help planners understand the needfor diversity and choice in housing

options for older people.”

Local Government Group (2010). Good homes in which to grow old?

housing and any minimum requirementswould assist in ensuring that any potentialdevelopers had an understanding ofexpectations prior to application. This mayform part of the Market Position Statement,Strategic Housing Market Assessment, or anexisting Local Development Framework.

Deciding on a local approachThis paper has explored the issues which needconsideration if an understanding of the localmarket is to be developed.

Looking at this alongside the understanding oflocal demand (described in paper 2) will enablecommissioners and providers to identify thetypes of housing, care and support services

that are needed to deliver local strategicoutcomes for the older population, includingthe role extra care housing could play in this.The remaining papers in this resource packconsider the planning, design and delivery ofextra care housing in this context.

Key messagesGood housing suitable for older people will only be developed if public care agencies and the local authority work together and that they work in partnershipwith Registered Social Landlords, the voluntary and private sectors. This needs to be across all forms of tenure.

Local authorities can help the sector bydeveloping, providing and discussing withall interested parties the shape of localhousing markets for older people now andhow they might be changed in the future.

Local reviews of sheltered housing stock are vital if the asset of sheltered housing is not to be lost.

Planning departments in local authorities need to recognise the future demographicmake-up of their communities and developLocal Development Plans that will help to create a wider choice of housing suitablefor older people, and assist in thedevelopment of rural and urbanenvironments that work for older people.


“More Londoners are living longer andmore older people are choosing to

remain in their own homes rather thango into residential institutions. To

address these and future needs, allLondon’s future housing should bebuilt to ‘Lifetime Homes’ standards

and 10 per cent should be designed tobe wheelchair accessible or easilyadaptable for wheelchair users.”

Greater London Authority (2011). The London Plan:Spatial Development Strategy for Greater London.

SECTION A

Tools and ResourcesThese tools and resources form part of Section A of theStrategic Housing for Older People Resource Pack. Theysupport the key activities commissioners, funders, providersand developers need to undertake to effectively plan anddeliver housing that older people want locally.

A1 Reviewing housing needs amongst older people – a checklist.

A2 Data sources for help in estimating demand andunderstanding the market.

A3 Conducting focus groups with pre-retirement populations.

A4 Assessing the capacity of current sheltered housing to meet future needs.

A5 Developing an Accommodation Strategy.

A6 Developing a Market Position Statement.

Each of these tools can be downloaded from the HousingLIN or IPC websites.

TOPIC

Baseline data

Minority andspecialistpopulations

Location

Housingcondition

Health

Current ServiceDemand

Wealth andeligibility forservices

QUESTIONS

How do we define older people (remember this is about planning to meet housing needin the relatively immediate future)? How many older people are there now, and will be inthe future (maybe at five year intervals for the next fifteen years)? How is thedistribution of older people likely to change (for example, changes in the proportion ofthe population that are aged 85 and over)?

Are there groups within the population potentially requiring specialist services? Forexample, people with a dementia, people with learning disabilities, sensory impairments,people from different faith groups?

Where and how, do older people currently live? For example geographical location,tenure and, household status. What is the level of under occupation? How might thispicture change over the next 10 – 15 years?

What is the general condition of housing occupied by older people? Roughly, whatproportion might be capable of adaptation, or is it already of a sufficient design standardto enable older people to remain living in it independently?

What is the health of the population? Given the known triggers for moves into specialisthousing and residential care, are there particular groups within the population likely toneed or want to move? What have been the recent results of health surveys concerning,falls, Chronic obstructive Pulmonary Disease (COPD), etc, where the person’s conditionmight be improved by better housing solutions? How is this reflected in local JSNAs ormeeting Clinical Commission Group or Quality, Innovation, Productivity and Prevention(QIPP) objectives?

What is known about current demand for health, housing and social care services? Arethere patterns of particularly high demand across the locality? How do these patterns ofdemand fit with the picture nationally? What is known about the expectations andpreferences of older people locally in terms of their housing desires?

What is the level of wealth and housing equity held by older people as compared to the regional and national average? How might this impact on housing provision or theself-funder market? What proportion of the local population is likely to meet local socialcare eligibility criteria? What proportion of the older peoples’ population currently inreceipt of residential care may have an alternative option given the development of extra care housing?

34 SECTION A: Tools and Resources download this tool at www.housinglin.org.uk/shop_resource_pack or http://ipc.brookes.ac.uk/shop.html

Reviewing housing need and demand amongst older people – a checklist

This checklist aims to provide a framework from which a basic population review can be conducted.It focuses on the data to be captured. Once retrieved it would be expected that significant trendscould then be identified. It might be expected that this activity would be a basic part of the work ofa Joint Strategic Needs Assessment (JSNA) or Strategic Housing Market Assessment (SHMA).

A1

http://www.housinglin.org.uk/shop_resource_pack

http://ipc.brookes.ac.uk/shop.html

TITLE

Joint StrategicNeeds Assessment(JSNA)

Projecting OlderPeople’s PopulationInformationSystem(POPPI)TITLE

Regional HealthObservatories

COMMENTARY

The JSNA should represent a combined view of demandacross health and social care and in some instanceshousing. Normally developed by Public Health bodies butvary widely in terms of size and focus.

The POPPI Demand Forecasting and Capacity Planningtool provides the latest National Statistics for the 65+population for individual local authorities down to districtlevel. Its forecasts extend to 2030 and are split by genderand age-band. Contains information on:

• Living status.

• Support arrangements.

• Health prevalence data.

• Older people and learning disabilities.

• Local performance data based on the latest PAF andRAP returns for services for older people.

At the time of writing the network of nine Public HealthObservatories in England are continuing to work togetherin collaboration on an agreed single work plan. TheAssociation of Public Health Observatories has beenformally dissolved but the website www.apho.org.uk willbe maintained during this period of transition until the newpublic health system for England is more fully in place.

ACCESS

Usually available via mostsearch engines throughusing the name of the localauthority and the title JSNA.Guidance on JSNAs andthe core dataset is availableat www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081097

Available atwww.poppi.org.ukACCESS

Regional HealthObservatories can bereached by contacting TheAssociation of PublicHealth Observatorieswebsite at www.apho.org.uk/ihc Regional Health Profiles2011 are available atwww.apho.org.uk/default.aspx?QN=HP_COMPARISON_RAGS_2011

SECTION A: Tools and Resources download this tool at www.housinglin.org.uk/shop_resource_pack or http://ipc.brookes.ac.uk/shop.html 35

>

Data sources for help in estimating need and demand and understanding the market

This table sets out some of the potential sources of data which could be considered whencompiling data around health and wellbeing generally, as well as how it relates to estimatinghousing need.

A2

http://www.apho.org.uk

http://www.dh.gov.uk/en/

http://www.poppi.org.ukACCESS

http://www.apho.org.uk/

http://www.apho.org.uk/default



TITLE

Risk PredictionTools

Forecast Lengthof Stay and Costtool (FLoSC)

Housing MarketAssessments

COMMENTARY

There are a wide range of risk stratification models in useacross the NHS. These models range from the Patients atRisk of Re-hospitalisation (PARR) and the CombinedPredictive Model (CPM) described below, to tools developedby commercial organisations to support long term conditionsmanagement. The Patients at Risk of Re-hospitalisation(PARR) tool has been developed by the King’s Fund inpartnership with Health Dialog and New York University.PARR is a software tool that uses inpatient data to identifyand predict patients at risk of re-hospitalisation within a year.It aims to improve the management of high-risk patients,particularly those with long-term condition through findinga way of identifying patients before their condition hasworsened and consequently avoiding avoidable admissions.

There is also a Combined Predictive Modelling tool that usesa broader and more comprehensive set of data to identifypatients who may become frequent users of secondarycare services, and whose condition is deteriorating butwho would not yet be picked up by PARR.

Care Services Efficiency Delivery (CSED) has developedFLoSC with the Health and Social Care Modelling Groupat Westminster University. FloSC is a practical softwaredecision tool for local authorities to Forecast Length ofStay and Cost of their clients in institutional long-termcare. It analyses the history of people in residential andnursing care and forecasts the future length of stay andcost of the people in care today, which those localauthorities are committed to caring for, based on pastdecisions. It provides an analytical base-line for budgetingand capacity planning and an indication of the opportunityto reduce this major element of social care costs.

Local Authorities under guidance from the Departmentof Communities and Local Government are obliged toproduce Strategic Housing Market Assessments (SMHA).This document should provide: estimates of currentdwellings in terms of size, type, condition, tenure and ananalysis of past and current housing market trends.Within the assessment there should also be an estimateof demand for affordable housing with a particularemphasis on identifying the needs of priority groups suchas key workers, people with a disability, etc. Theseassessments should, although may not, includeinformation about demand for housing for older people.

ACCESS

For a list of tools that arein use on predictivemodelling in the NHS goto: www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_129779.pdf

FLoSC can be found atwww2.wmin.ac.uk/hscmg/flosc/

The guide to StrategicHousing MarketAssessments can be foundat www.communities.gov.uk/publications/planningandbuilding/strategichousingmarket.Individual SHMAs arenormally available onwebsites through searchingby local authority nameand SHMA.


>

http://www.dh.gov.uk/prod

http://www.communities.gov



TITLE

Local InvestmentPlans andagreements

Choice-basedlettings andother housingregisters

English HousingSurvey (EHS) andlocal authorityprivate stockcondition surveys

ElderlyAccommodationCounsel (EAC)

Social Trends,Office ofNationalStatistics

SIGNet

COMMENTARY

Local Investment Plans have been developed out of theSingle Conversations held in localities by the Homes andCommunities Agency (HCA) with local authorities and keystakeholders, and set out to describe the level of and rationalefor social housing investment. These are now voluntary.66

Information about current unmet local demand asexpressed in applications for housing will be availablefrom the organisations managing choice-based lettings orholding housing registers in each locality.

The EHS collects information about people’s housingcircumstances and the condition and energy efficiency ofhousing in England. Each local authority is required tounderstand the private sector housing condition in its ownarea typically through surveys carried out every five years.

EAC draws on its database of information about UKhousing provision and care homes for elderly people toproduce publications, analyses, mapping and informedcommentary of benefit to housing and care providers,funders and policy makers.

An established reference source, Social Trends drawstogether social and economic data from a wide range ofgovernment departments and other organisations; itpaints a broad picture of UK society today, and how ithas been changing.

Useful online tool developed by Homes and CommunitiesAgency (HCA) to inform investment decision making. Itallows users to access the HCA’s data hub and to interactwith data on a map interface. Users can search for, loadand explore data sourced from a variety of organisationsincluding The Environment Agency, Local Authorities,Office for National Statistics and Ordnance Survey.

ACCESS

Via HCA website atwww.homesandcommunities.co.uk/inyourarea

Via local housing authority websites forcontact details.

EHS is available atwww.communities.gov.uk/housing/housingresearch/housingsurveys/englishhousingsurvey/ Surveys are usuallypublished on localauthority websites forindividual localities.

Further information isavailable atwww.housingcare.org

ACCESSReports are available athttp://data.gov.uk/dataset/social_trends

Contact your local HCAInvestment Manager fordetails.


66 Homes and Communities Agency (2010). Local Investment Plans – Core elements.

>

http://www.homesandcommuniti

http://www.communities.gov.uk/

http://www.housingcare.org

http://data.gov.uk/dataset



TITLE

Strategic HealthAsset Planningand Evaluation(SHAPE)

COMMENTARY

SHAPE is a web enabled, evidence based applicationwhich informs and supports the strategic planning ofservices and physical assets across the whole healtheconomy. It:

• Links national datasets for clinical analysis, public health,primary care and demographic data with estatesperformance and facilities location.

• Enables interactive investigations by healthcommissioners and providers and local authorities.

• Supports key policy initiatives such as QIPP, JSNA andTransforming Community Serivces.

ACCESS

http://shape.dh.gov.uk/


http://shape.dh.gov.uk/



Aim The aim of the focus groups is to understandfrom immediate pre-retirement age groups theirplans and thoughts about care and support inold age. The focus groups should be semi-structured and run for approximately two hours.

FacilitationThe groups should be facilitated by a skilledfacilitator to pose questions, seek clarificationand promote dialogue between participants.One facilitator should not conduct more thantwo focus groups in one day. The facilitatorshould be seen to be independent of councilcare services but could be a suitably trainedcouncil employee. A suggested approach isprovided in Anticipating Future Accommodation Needs68.

RecordingAn experienced note taker responsible forsummarising the main themes should also bepresent. Tapes can be used but a note taker isoften less obtrusive and can act as a usefulsounding board in testing results with thefacilitator. Observers are not recommended

given that there is a risk of the discussion beinginhibited or observers being drawn into thedebate. In addition to the facilitator and therecorder, it is also helpful to have a third personto manage logistics and follow-up if anyparticipant is distressed.

ParticipantsTo get a reasonable sample across a localauthority, organisers might wish to aim for fiveto ten groups (depending on the size of theauthority) involving no less than eight and nomore than twelve participants in each group(groups with less than eight people may notpromote discussion; with more than twelve,some participants may not contribute). It isimportant to avoid the ‘usual suspects’, ie,people who are regularly involved inconsultation exercises.

Recruit participants aged between 63 to 65years and who are broadly representative of thelocal population in terms of gender, socio-economic status, tenure, and ethnicity.Obtaining a sample has been achieved by localauthorities in a number of ways; through co-operation with the local Department for Workand Pensions, using bus pass lists, citizens’


67 This approach is based on work that IPC conducted for CSED as published in: CSED (2007). Anticipating Future Needs toolkit.

68 Housing LIN (2007). Case Study 31: Anticipating Future Accommodation Needs: Developing a consultation methodology.

Conducting focus groups of pre-retirementpopulations designed to explore theirresponses to future problems as they age67

When estimating future demand for services it is important to understand what people’sexpectations might be and what would be their preferences. This brief guide describes an approach for conducting focus groups with pre-retirement populations. It is designed to elicit an understanding of the types, and characteristics, of services which people might expect to see if they become frailer or develop specific health needs.

A3



panels and advertising in local newspapers,libraries and shops. It may be important to getpeople to record at the start their approximateincome, age and type of tenure/housing theyoccupy. For some people it may be necessary toconsider making practical arrangements if theyare full time carers. Some groups should be heldin the evening to allow people who work toparticipate. It is important to reimburseparticipants’ expenses incurred in attending.Most focus group organisers give people someform of honorarium, commonly in the form ofshopping vouchers.

VenuesVenues should have good transport links, easyaccess for those with disabilities and appear‘agency neutral’ and not old age-biased, ie, notpart of the local authority, health service orvoluntary sector working with people in old age.

At the venue, provide level space forwheelchairs and walking frames, facilitiesfor people with hearing difficulties,

comfortable facilities with accessible toilets, and adequate breaks.

TimetablingPlan how people will be welcomed on arrival,how refreshments will be served and how tomanage late arrivals. Have refreshments beforethe session begins rather than in the middle as abreak may cause the discussion to losemomentum; refreshments at the end may causeconfusion over when the discussion terminatesand get in the way of the next group coming in.




Assessing the capacity of current shelteredhousing to meet future needs

As part of understanding the supply in a given locality, it is important to understand existingsheltered housing provision and the contribution it could make to delivering strategic outcomes for the older population. For each sheltered housing scheme this checklist is designed to:

• Enable the development of a strategic view of sheltered housing stock in a locality, and assess its likely contribution to strategic outcomes for the older population.

• Assess whether the sheltered housing stock is able to meet the needs of older people both now and in the future.

• Categorise stock to enable future prioritisation for refurbishment, remodelling or other investment, or decommissioning.

A4


Standard andcondition

• What type of scheme is it, including age, size, type ofaccommodation? Is the accommodation very small orare the facilities old-fashioned?

• What is the current standard and condition of thebuilding both internally and externally? How does thescheme perform against national standards, such asLifetime Homes or DDA compliance? Does it requiremajor refurbishment and is it capable of bringing up tostandard affordably?

• How does it perform in terms of energy efficiency andsustainability69?

POTENTIAL SOURCES OF INFORMATION

Information gained fromresident involvement activitiesand customer feedbackincluding complaints.Elderly Accommodation Counseldatabase at www.housingcare.orgProvider data including propertycondition surveys and responsemaintenance information.Bespoke surveys of providersincluding site inspections.Use of the ‘Evolve Tool’70 toassess to assess how well abuilding contributes to bothphysical support of older peopleand their personal well-being.

INFORMATION NEEDED FOR ASSESSMENT

69 See: Housing LIN (2010). Technical Brief 4: Extra Care Housing: Designing, assessing and delivering sustainable homes.

70 The Evolve Tool http://www.housinglin.org.uk/Topics/browse/Design/DesignGuides/?parent=6594&child=7997

>

http://www.housingcare.org

http://www.housinglin.org.uk/Topics/browse/Design/DesignGuides/?parent=6594&child=7997



Value anddemand

Accessibilityandadaptability

• What are the number and length of voids at thescheme? Is the scheme, or particular flats within it,increasingly difficult to let? Have flats been let toyounger people in order to ensure voids are filled?

• Why do people leave the scheme, and what might thissuggest about its suitability for older people?

• What is the value of the scheme, both in terms of the building, the land, and its current density? Couldthere be options to increase the density? Would itprovide an opportunity to realise capital to invest in more appropriate housing?

• What are the current levels of care and supportprovided into the scheme?

• Does the footprint allow for additional communal facilities?

• Does the building promote or restrict independent livingthrough its design? Are there identified factors which mightlimit the potentiality for change, internal pillars, asbestos, etc.

• Can the scheme support older people with a physical,sensory or mental frailty?

• Is the building wheelchair accessible, and howaccessible is the immediate area? Are there facilities forre-charging mobility vehicles?

• Is the building capable of making use of assistivetechnology, or to what degree is it doing so already?

• Are there good local facilities which are readily accessible?

• Is there sufficient storage space?

POTENTIAL SOURCES OF INFORMATION

CORE data (ContinuousRecording of Lettings andSales in Social Housing inEngland) https://core.tenantservicesauthority.org/Local housing register orChoice Based Lettingsdatabases.Provider lettings and sales data.Social care data (care andsupport provision).Local land registry data.

Resident and staff surveys,focus group discussions andone-to-one interviews71. Bespoke provider surveys andscheme visits.Discussions with local healthand social care professionals.

INFORMATION NEEDED FOR ASSESSMENT

71 For further information about effective consultation see: Pensions Advisory Service and Centre for Housing and Support (2010).Effective Resident Involvement and Consultation in Sheltered Housing – A Good Practice Guide for Providers and Commissioners.


https://core.tenant



Developing an accommodation strategy

Many local authorities will already have older person’s accommodation strategies; for some thiswill be part of a wider older person’s or adult social care document, for others it may be in theform of a market position statement. The purpose of an accommodation strategy in this context isto describe the role that accommodation performs in delivering care and support. This mayencompass the future role of residential care, of extra care and sheltered housing and housingsupport services, such as care and repair or assistive technology. It is likely to straddle both publicand private sector housing. The material below offers a template for developing such a strategy.

A5

SummaryThis should give a summary of the overall strategyand the agreed approach over a particular timeperiod. It should include the investment/disinvestment to be made over that period. It canbe produced as a separate, short document, or asan ‘executive summary’ at the front of the strategy.

IntroductionThe introduction states the purpose of thestrategy and shared values and vision. Itprovides a brief picture of the range ofaccommodation and services underconsideration and identifies the priorities andthe outcomes that the strategy is trying toachieve. It may also contain a definition ofcommissioning. Often, there will be a briefdescription of how the strategy was developed,ie, the process or methodology undertaken andthe partners who have agreed its content.

Legislation, national and local guidanceThis should bring together requirements thatare either advised or mandatory for theorganisations developing the strategy, together

with statements about organisational goals andvalues where they have a bearing on thestrategies development.

Demand forecastingThis should contain the analysis from a broad-based review of demographics, research,surveys of relevant populations (both nationaland local), surveys of user, carer and patientneeds and the key aspects of conditionaldemand to be addressed, ie, known unresolvedneeds of the population. It should conclude byidentifying the target groups for different typesof accommodation provision and the needs thiswill fulfil. This might include defining whoresidential care is for as well as who theauthority thinks it is not for, and the role thatassistive technology might perform.

Supply analysisThis has a number of components, which buildto present a picture of existing services andtheir use as well as a wider picture of themarket and an assessment of current gaps inservice availability or performance.

• A ‘map’ of accommodation – where isspecialist accommodation (residential care,




supported housing, extra care, retirementvillages) currently located. If in local authorityor Registered Social Landlord ownership, whatis its value and state of repair? With regard tosheltered housing and care homes it shouldestimate their future fitness for purpose interms of: future suitability and viability asextra care housing provision; their capacity tomeet regulatory requirements in the case ofcare homes; current and likely future demand;and any service or scheme improvements.

• A ‘map’ of relevant services – including thefull range of services being provided,showing where services relevant to extra carehousing are located and the organisationproviding them.

• Service quantity – is there known under- orover-supply of services? This section mayinclude information on referral andassessment mechanisms, take-up of services,occupancy/vacancy levels,effectiveness/outcomes of services andwaiting times.

• Service performance – whether services aremeeting needs fully or partially. To be gainedfrom; inspection reports, performance indicators,service user and carer views relating to therelevance and quality of care through theanalysis of complaints, and informationderived from user/carer forums and feedbackfrom the contract monitoring process.

• Contracting – the contractual arrangement inplace and any strengths and/or weaknessesin these arrangements.

• Finance and funding – a picture of thefinancial resources available now andpotentially over the period of the strategy.Some strategies include a survey of costs andcharges and show comparisons withneighbouring or equivalent authorities.

• The market (if a separate market positionstatement is not being developed) – whatare the current and future trends inprovision? The analysis could also include an assessment of land or house prices andtheir impact on the market, as well as anassessment of the robustness and capacity of the independent and voluntary sector.

This section may include known plans ofservice providers and any local consultationthat has taken place.

Gap analysis and the designof future provisionThis section is the hub of the strategy. It bringsthe demand and supply material together,analyses obvious shortfalls in provision now andin the future and how such gaps may be met,together with a view of the capital and revenueresources required and how they may befunded. It should spell out the shape of futureservices and the strategic priorities necessary toachieve them within the time-frame of thestrategy, and appraise the options available,including risks.

Monitoring arrangementsThis section has two purposes:

• To make clear how the strategy will bemonitored in order to determine whether thestrategy is shaping services in the way intended.

• To guide the development of monitoring of accommodation provision and services in the future.

In terms of the latter, it may be appropriate toinclude an assessment of the effectiveness ofcurrent monitoring and performance managementarrangements, if changes to the systems arenecessary. It is important to recognise thatmonitoring and the collection and analysis ofdata has a cost consequence for bothcommissioners and providers and this should becarefully considered in designing new systems.

Action PlanA brief, snappy, review of the agreed next steps and whose responsibility it is to take these forward.




Developing a Market Position Statement for housing for older people

Increasingly the role of local authorities towards housing markets is changing. From beingdevelopers and providers of specialist housing they have moved to being commissioners ofaccommodation, and now to one where their task is to facilitate the market in order to ensuresufficiency of supply. Such a move increasingly recognises that the majority of the older people’spopulation lives in accommodation that they own and will continue to wish to do so, even ifmoving to specialist accommodation.

A6

What should a MarketPosition Statement contain?A Market Position Statement is a documentprepared by the local authority in cooperationwith, and for, the market. In terms of extra care housing, this is particularly important given that much of the future provision ofaccommodation for older people is likely to be developed by the private and voluntarysectors72. It should bring together data from the JSNA, from commissioning strategies, and from market and customer surveys into a single document.

It should be market-facing, ie, containinformation the authority believes, and cansubstantiate, would be of benefit to housingand care providers across housing associations,the voluntary and private sectors.

Other characteristics of a Market PositionStatement are that it should:

• Cover the whole housing and care market, notjust the sector that the local authority funds.

• Indicate how the local authority intends tobehave towards the market in the future.

• Be a brief and analytical, rather thandescriptive, document.

• Be evidence-informed in that each statementit makes should have a rationale thatunderpins it, based on population estimates,market surveys, research etc.

Finally, a Market Position Statement is not anend in itself, it should represent a ‘calling card’,an introduction for deeper discussions bothwithin the public sector, across planning, health, housing and social care and withproviders of accommodation. Many of theactivities involved in developing a MarketPosition Statement will already be undertakenby voluntary sector and private companies in developing their business plans.

72 See: further discussion of market facilitation more generally, and Market Position Statements in particular in papers published by theNational Market Development Forum available at Institute of Public Care





TOPIC

How is the local marketstructured, eg, in termsof size, value, users,location, etc?

Are there any changesin demand that providersare experiencing andare these quantifiable?

What are the currentpressures in the local market?

What is the quality ofspecialist housing forolder people acrosssectors?

What surveys of thegeneral public and ofservice users have beenconducted?

Can these be broughttogether with materialfrom inspection reportsand national researchinto clear indicationsabout reactions tocurrent service provisionand future desires?

What might olderpeople want in terms of future provision?

QUESTIONS

In terms of structure the wider consideration of supply is on a threefold basis:

• General housing supply and take-up within a given population, eg, who lives inwhat kinds of housing, by tenure.

• Supported housing; who delivers, in what volume and where? How does thismatch the distribution of the relevant population?

• Care and support services, with a particular focus on those services designed tosupport people in the community, eg, home care, care and repair, housingrelated support, etc.

Make sure the view of the market is not just a snap-shot but shows trends overtime and the scale of change. Are there geographical distinctions in the waypopulations are distributed?

Explore with providers whether they have noticed any significant changes in thefrailty and age of people referred to and living in their schemes. For example, arethere voids in sheltered housing – is this down to the size or location of theaccommodation? Understand the current pressures providers are currently comingup against to meet demand.

Review surveys and materials to understand what older people think about therange of accommodation and support services that are currently provided. To helpachieve this there are a number of sources of published data, such as the results ofCQC inspections, Supporting People QAF data, property condition surveys, as wellas information to be gained from consultations with older people currently usingservices, or from mystery shopping exercises.

Analyse the information collected in order to understand whether: prices differwidely between providers; the difference in quality between high cost and lowcost services of the same type; and the price differences between servicesprovided by private providers or Registered Social Landlords?

What sensitivity is there to price and what relationship do people establishbetween price and service quality? For example, where will they want to live,what standard of accommodation will they expect to live in, are there sectors ofthe market where people would be prepared to pay more for enhanced provision?

>

DEMAND AND DISTRIBUTION



TOPIC

THE CURRENT MARKET

What is the currentcapacity and capabilityin the marketplace?

What demands arebeing placed onproviders?

What are the driversbehind the market?

What businessopportunities areregarded as mostdesirable?

What is the scope forinnovation andexpansion in themarket?

QUESTIONS

Capacity and capability might mean a number of different things to different people:

• Potential to take on additional work or develop particular schemes.

• Capability in terms of past knowledge as against current enthusiasm, eg, could alocal builder who lacks the knowledge for the development of an extra carescheme, make up that deficit through price, enthusiasm and readiness to beinnovative and work with partners?

• Are there current areas of supply that are under-utilised and/or no longer indemand, eg, bedsit sheltered housing, day centres?

• Are there current sectors that are under-supplied, eg, flexible night care staff,specialist dementia services or respite care to people with profound and multiple disabilities?

Some of the issues around capacity may be about the capacity of an organisationto either expand or realise what they are taking on, eg, a voluntary sector bodythat may over-reach its capabilities or require additional help with businessplanning and support.

There are potentially a range of policy and financial drivers behind new thinking in terms of accommodation, care and support for older people. Some of thesupply side factors may be driven by evidence that there is new unfulfilleddemand for which there is a viable response, eg, a growth in the number ofpeople who might wish to move into a retirement village. The financial side may be around efficiency savings across housing, health and/or social care or seeking a good return on investment in the sector.Some aspects of demand may arise from questioning current provision. For example:

• Do people move from specialist housing because their needs are perceived(often by others) as being too great to be met within current accommodation?

• Are people reluctant to make a move because they perceive the options availableto them as unattractive or not meeting their lifestyle needs and/or desires?

• Are there people self-funding their care home place and running out of funding?

• Are there people who might wish to purchase a retirement property but there are none available?

• Are there people in care homes who are funded by the local authority whocould have improved quality of life within an extra care scheme?

• Is there a lack of flexible, responsive home care, particularly at night, which isincreasing demand for accommodation-based services?

• Are there new financial products/procurement vehicles that can help stimulategrowth in the market through access to private equity, social finance/impactbonds or public/private sector partnerships?

Developing this understanding of the market will enable commissioners andfunders to plan how they will need to influence and shape the market to ensure it can deliver the strategic outcomes it has developed for its local population.


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TOPIC

Are there barriers tomarket entry?

DEFINING THE FUTURE

What is the authority’sview of good practice,in particular not just the shape of individualservices but their overall configuration?

What are the indicativecost-benefits ofdifferent types ofservice provision?

QUESTIONS

There might be a number of barriers to market entry both real and perceived byproviders. However, if the market is to be stimulated then commissioners andfunders need to recognise providers’ concerns and mutually explore how theymight be overcome. Such barriers might include:

• The financial viability of developing a scheme or a particular service.

• Guarantees about long term funding (both capital and revenue), particularly in aworld of personalised services where take-up of provision may have become lesscertain.

• Obtaining land and planning permission.

• Improving the ‘value’ on build costs and streamlining the construction process.

• Competition, from within or outside the sector, or from the local authoritysubsidising its ‘in-house’ service.

Review national, regional and local best practice of what constitutes an effectivemarket for housing for older people. Specifically what are the characteristics andthe make-up of an effective local market? How does best practice compare toyour current market position?

Make an assessment of the cost benefit of providing each type of accommodation for older people. For example, what impact will the availability of extra care housing have on the need for residential care and therefore costs saved or reallocated?



About the Housing LINPreviously responsible for managing the Department of Health’s Extra Care Housing Fund, theHousing Learning and Improvement Network (LIN) is the leading ‘knowledge hub’ for a growingnetwork of 5,700 of housing, health and social care professionals in England involved inplanning, commissioning, designing, funding, building and managing housing, care and supportservices for older people and vulnerable adults with long term conditions.

For further information about the Housing LIN’s comprehensive list of on-line resources andshared learning and service improvement networking opportunities, including site visits andnetwork meetings in your region, visit: www.housinglin.org.uk

About the ADASS Housing NetworkThe ADASS Housing Network aims to represent the Association of Directors of Adult Social Serviceson all major issues as they impact on housing and our adult service users. It has a special focus onsupporting people and personalisation and takes a careful interest and overview of policy andpractice developments in supported and specialist housing for older people and vulnerable adults.

The Network comprises of adult social care directors and lead officers, many of whom also have housing responsibilities, reflecting the growing importance of linking housing andcaring to other agencies within and beyond the local authority. For further details about ADASS, go to: www.adass.org.uk

About the Institute of Public CareThis resource pack has been authored by the Institute of Public Care at Oxford BrookesUniversity. The Institute works with central and local government, private and voluntary sectors,Registered Social Landlords and the NHS in order to enhance their impact and effectiveness. This is achieved through analysis, evaluation and redesign of services, help with implementingchange, skills development, information management, and knowledge exchange.

For further information about IPC’s range of activities and publications, including its programmeof activities to support commissioners, developers and providers of housing for older people andits certificate programme go to: http://ipc.brookes.ac.uk

The views expressed in this Resource Pack are those of the authors and are not necessarily thoseof the Housing Learning and Improvement Network or ADASS.

PUBLISHED BY:

Housing Learning and Improvement Networkc/o EAC, 3rd Floor, 89 Albert Embankment, London SE1 7TP

tel: 020 7820 8077 email: [email protected]

DECEMBER 2011

http://www.housinglin.org.uk

http://www.adass.org.uk

http://ipc.brookes.ac.uk

mailto:[email protected]

strategic housing for older peoplea comparatively fit and healthy early old age with relative wealth...

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